Delayed Cord Clamping

by Alisha Madrone, CNM

As a midwife, I am often approached about my perspective on all things women. Most recently was an inquiry into my thoughts on umbilical cord clamping.  I began to explain delayed cord clamping as one of the many intuitive ways in which I practice midwifery, while at the same time citing some of the known benefits of this practice. As is the nature of my desire to balance science with the art of midwifery, I left the conversation inspired to ensure my knowledge was up to date. The words that follow reflect some basic definitions and my investigation of the more recent research regarding umbilical cord clamping.

Background:
The umbilical cord consists of a single vein that carries oxygen and nutrient-rich blood to the growing babe and two arteries (though occasionally just one) that carry deoxygenated and nutrient-depleted blood away. These vessels are covered with the very thick and protective Wharton’s jelly, which gives the umbilical cord its white shiny appearance and tough texture. The umbilical cord enters the fetus/baby in the abdomen and connects to the mom’s circulation via the placenta.

In response to life outside the womb (primarily air and temperature), the vessels in the umbilical cord constrict shortly after birth and gradually cease blood flow. This process, if uninterrupted, is thought to take anywhere from 5 to 20 minutes and is otherwise at the discretion of the birthing mom or birth attendant. Because there are currently no clinical guidelines for the timing of umbilical cord clamping, personal preference is often the deciding factor of when the umbilical cord is clamped and cut. For the purposes of the following findings, delayed cord clamping is
defined as clamping after the first minute of life or when the cord stops pulsing.

Proven Benefits of Delayed Cord Clamping:
Increased blood volume – By delaying cord clamping the natural transfer of blood from the placenta to the baby occurs making up to 40% more blood available for the baby.

Increased iron stores – Iron helps to transport oxygen-rich blood in the body and plays an important role in the development of a baby’s brain. By delaying cord clamping, a baby’s iron stores are increased at levels that are sustained through the first few months of life.

Increased rate of stem cell transfer – By delaying cord clamping, the rate of stem cell transfer to the newborn is increased. Stem cells may play a role in the prevention of certain blood disorders and immune conditions.

Decreased incidence of anemia – Iron deficiency is the primary cause of anemia, which can lead to problems with brain development early in life. Delayed cord clamping increases hemoglobin and hematocrit levels, which decreases the risk of anemia by an estimated 47%.  This reduction continues to be observed for 2-6 months after birth.

Risks?  Polycythemia (increased blood viscosity) is the only con of delayed cord clamping, a condition that is statistically significant, but none of the polycythemic infants were symptomatic or needed any treatment.  There is also some studies that cite jaunice as a potential concern, but again the literature did not document a need for treatment.

Summary:
Given the known benefits to the newborn and lack of documented risk, the practice of delaying cord clamping by one to three minutes or until the cord stops pulsing seems a reasonable consideration for all women.

Alisha Madrone, CNM, offers quality women’s health care and midwifery services out of Zenana Spa and Wellness Center and has the honor of attending home and hospital births.

For further resources or information, contact Alisha at FlourishWomensWellness@gmail.com.

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